The Impact of Donor Type and Quality on Renal Transplant Outcomes

Renal transplantation improves survival of patients with end-stage kidney disease (ESKD) (Wolfe, McCullough et al. 2009). In most countries, including the United States and Australia, there continues to be a growing disparity between the limited availability of deceased-donor kidneys compared to potential transplant candidates. In contrast, livedonor kidney transplantation has been steadily increasing over time. It has been well established that the type (live or deceased donor kidneys) and quality (donor age and presence of donor comorbidities) of donor kidneys have a significant impact on renal allograft outcomes. In this chapter, we will focus on both live-donor and deceased donor kidney transplantation and the impact of donor factors and types on graft and patient outcomes. With the continuing shortage of deceased donor kidneys coupled with a growing number of older transplant candidates, there has been a greater acceptance of using older donor kidneys, including increased utility of expanded criteria donor (ECD) and donation after cardiac death (DCD) kidneys. We will look at the impact of using ECD and DCD kidneys on graft and patient survival, and to identify modifiable factors that may improve transplant outcomes in recipients receiving ECD and DCD kidneys. Finally, we will discuss whether the implementation of utility-based allocation strategies for deceased donor kidneys is an appropriate way forward to provide a balance between utility and equity in the distribution of deceased donor kidneys.